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Exchange and Colorado Option Forms | Documents | Links

Forms

Appointment of Personal Representative
Colorado Option Member and Provider Demographic Survey
Care Management Referral
Commercial Dependent Eligibility Beyond Limiting Age
Coordination of Benefits
Complaint and Appeal Form
Emancipated Minor Restriction of Claims Access

Member Reimbursement Form
Pharmacy Prior Authorization Request
Serious Mental Illness Step Therapy Exception Form
Standard Exception Form for Contraceptives
Subscriber Access to Spouse or Adult Dependent Claims
Transition of Care/Continuation of Care Request
Uniform Individual Health Benefit Plan Application

Documents

Access to Care
Advance Directive / Living Will / CPR Directive
Commercial Plan Service Standards

Epinephrine Auto-Injector Affordability Program
How to Read Your EOB

Links

Affirmative Statement About Incentives
Continuous Glucose Monitor Usage
Emergency / Non-Emergency Out-of-network Disclosure
Essential Health Benefits
Gender-Affirming Care
Glossary
Infertility - Member FAQs
Lifeline Program (Phone and Internet)
Member ID Card

Member Newsletters
Member Rights & Responsibilities
MyDHMP Member Portal
Pay My Premium
Price Transparency
Services Requiring Prior Authorization
US Preventive Services Taskforce Recommendations
Wellness Blog
Women's Preventive Services Guidelines
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